Twin gestation in a uterus didelphys with only one functional cervix: A case report.

INTRODUCTION: Twin gestation in a uterus didelphys with one fetus in each uterine cavity is rare and presents unique challenges in antepartum and intrapartum care. CASE PRESENTATION: A 35-year-old woman with a uterus didelphys became pregnant with twins, with one fetus in each uterus, after intrauterine insemination of a single visible cervix. Multiplanar ultrasonography showed the presence of one complete cervix and a second hypoplastic cervix; it was unclear whether she could deliver both twins vaginally. Her pregnancy was complicated by fetal growth restriction of twin B. At 38 weeks, the patient underwent scheduled cesarean section and delivered two viable twins. CONCLUSION: Determining the precise anatomy of Mullerian duct anomalies, including the cervix and vagina, is important for obstetrical management.

Non-malignant Sequelae after Unconfined Power Morcellation.

STUDY OBJECTIVE: To identify the incidence of repeat surgery and subsequent findings after the performance of unconfined uterine power morcellation. DESIGN: A retrospective descriptive study (Canadian Task Force classification II-2). SETTING: Southern California Kaiser Permanente Medical Centers. PATIENTS: Women (N = 5154) who underwent laparoscopic supracervical hysterectomy with unconfined power morcellation. MEASUREMENTS AND MAIN RESULTS: Of the 5154 cases, 279 (5.41%) underwent subsequent reoperation with a median of 24 months after index surgery. The most common clinical complaint leading to laparoscopic supracervical hysterectomy was symptomatic leiomyoma (n = 135, 48.4%) and abnormal uterine bleeding (n = 94, 33.7%). The most common indication for reoperation was a symptomatic adnexal mass (n = 87, 31.2%) followed by pelvic pain (n = 83, 29.7%). The majority (n = 128, 60.4%) of subsequent non-urogynecologic-related reoperations resulted in benign pathology. Endometriosis was the primary pathologic diagnosis in 65 of 279 (23.3%) of the reoperative cases; this was not previously documented in 86% (n = 57/65) of these cases. The overall frequency of subsequent pathology was endometriosis (65/5154, 1.26%), disseminated leiomyomatosis (18/5154, 0.35%), and new malignancy (11/5154, 0.21%). CONCLUSION: Morcellation of nonmalignant tissue is not without consequence. Pathology confirmed endometriosis was documented for the first time in 20.4% of patients who underwent a second surgery. This finding raises the suspicion that morcellation and dispersion of the uterine specimen may be associated in the development of endometriosis.

Benign ovarian masses.

Primary tumors of the ovary are uncommon in children and the majority of these masses are not malignant. As newer diagnostic imaging techniques have increased the detection of all ovarian masses, the frequency of ovarian cancer has actually decreased. Clinical symptoms are generally not helpful in distinguishing benign from malignant masses, but radiographic criteria have been developed. Surgical treatment is aimed at ovarian preservation if the lesion proves benign.